慢性脓胸纤维板剥脱术中行肺叶裂游离的治疗效果分析

Analysis on efficacy of surgical lobar fissure free in patients with chronic empyema by using stripped pleural fibreboard

目的分析纤维板剥脱术术中行肺叶裂游离的慢性脓胸患者的治疗效果。方法江西省胸科医院胸外科92例需要手术治疗的慢性脓胸患者(结核性脓胸87例和非结核性脓胸5例)以数字表法随机分成两组,46例采用单纯脓胸纤维板完整剥脱术(对照组),46例采用脓胸纤维板完整剥脱术+术中叶裂游离(实验组),对两组手术时间、术中出血量、术后24h引流量、平均带管时间、术后住院时间、肺功能改善情况进行比较。结果实验组手术时间(148.52±45.38)min、术中出血量(372.41±241.89)ml、术后24h引流量(252.10±120.18)ml、术后带管时间(4.51±4.01)d、术后住院时间(14.58±3.90)d;与对照组[手术时间(142.97±47.61)min、术中出血量(333.35±301.19)ml、术后24h引流量(260.58±111.48)ml、术后带管时间(4.34±7.53)d、术后住院时间(15.28±6.35)d]比较,差异无统计学意义(t=0.572,P=0.569;t=0.686,P=0.495;t=-0.351,P=0.726;t=0.133,P=0.895;t=-0.693,P=0.524);而实验组肺功能改善情况[肺活量增加量(0.43±0.08)L,最大通气量增加量(15.81±3.71)L]明显优于对照组[肺活量增加量(0.37±0.12)L,最大通气量增加量(13.89±3.58)L](t=2.923,t=2.510;P值均<0.05)。结论慢性脓胸纤维板剥脱术中行叶裂游离对患者的手术时间、术中出血量、术后24h引流量、术后带管时间、术后住院时间无明显影响,且能够明显改善慢性脓胸患者术后肺功能,是慢性脓胸治疗中一种值得推荐的方法。

Objective To analyze the efficacy of surgical lobar fissure free in the chronic empyema by using stripped pleural fibreboard. Methods Ninety-two patients with chronic empyma, who admitted in Jiangxi Chest Hospital, were randomly divided into experimental group and control group by 46 cases each. Each group was treated with stripped pleural fibreboard, meanwhile in the experimental group additional using surgical lobar fissure free. We analyzed the two groups＇ operative duration, blood loss, drainage quantity after 24 h postoperatively, intubation time, postoperative length of stay and pulmonary function. Results The experimental group and control group＇s operative time were （148.52±45.38） min and （142.97±47.61）min, blood loss were （372.41±241.89）ml and （333.35±301.19）ml,drainage quantity after 24 h postoperatively were （252.10±120.18）ml and （260.58±111.48）ml, intubation time were （4.51±4.01） d and （4.34±7.53） d, postoperative length of stay were （14.58±3.90） d and （15.28±6.35） d, respectively. There was no statistically difference between the two groups. And the experimental group＇s lung function improved significantly, including vital capacity and maximal voluntary ventilation both increased remarkably compared with the control group （P〈0.05）. Conclusion Surgical lobar fissure free for the chronic empyema by using stripped pleural has no effect on the operative duration, blood loss,drainage guantity after 24 h postoperatively, intubation time, postoperative length of stay, and it could improved the patients＇ lung function remarkably, it＇s worth to be recommended widely.